He didn't suspect that he had swallowed a deadly shard of wood.

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Toothpicks seem so innocent. Whether staking down juicy sliders on game day or harpooning fruits bobbing in happy-hour cocktails, the mini skewers often spike our festive occasions. But, make no mistake, they have a vicious side. Given the chance, they will mess you up.

Of the poor souls who somehow ingest one of the wee daggers, 79 percent will end up with stab wounds their innards. Ten percent will die from their toothpick-inflicted injuries.

A new case study in the New England Journal of Medicine lays out some of the gory details behind those stats. A team of Boston doctors tell the woebegone tale of an unnamed, 18-year-old professional athlete who unknowingly swallowed a wooden toothpick. After weeks of abdominal pain, multiple visits to emergency rooms, bloody poops, and a life-threatening infection, doctors finally discovered it—lodged in his colon, piercing through his intestinal wall and into a neighboring, large artery. Then there was the harrowing effort to remove it and patch him up.

The saga began while the fellow was traveling in the southeastern US for athletic training. He was suddenly struck by a bout of diarrhea, nausea, fever, and pain in the lower right part of his abdomen. So he went to an emergency department to get checked out. But after scans and blood tests, the doctors were stumped and discharged him after five hours without a specific diagnosis.

For the next two weeks, he felt a bit better; the pain and fevers subsided. But then on another training trip—this time to the West—the pain returned, with bloody stools and a fever above 103 degrees Fahrenheit. Back in an emergency department, doctors ordered an MRI but again couldn’t figure out what was causing his symptoms. The team’s internist encouraged him to return home to New England for further medical evaluation.

Back home a few days later, the internist saw him at an outpatient clinic and arranged for him to have a colonoscopy to try to find the source of the trouble. But the next morning, the unlucky chap called the doctor saying that he had taken the bowel-preparation regimen for the procedure and had a bowel movement with a “large volume of blood.” He was also suffering from chills, fever, and intense pain. The internist told him to head to the emergency department at Massachusetts General Hospital immediately.

The toothpick.

NEJM

An illustration of how the toothpick was found.

NEJM

During colonoscopy, blood was found throughout the sigmoid colon (Panel A). A wooden toothpick was visible 25cm from the anal verge, with evidence that it had eroded the colon wall (Panels B and C).

NEJM

After the toothpick was removed, pulsatile bleeding occurred (Panel E). The bleeding was addressed with placement of nine hemostatic clips and administration of a total of 10ml of epinephrine (Panels F and G). Ongoing bleeding was noted at the end of the procedure, and emergency surgical consultation was obtained.

NEJM

Once there, his condition worsened, and he was admitted. Tests found bacteria in his bloodstream. His fever spiked to 105 degrees, he appeared confused, his heart raced, and he was breathing rapidly—all indicating sepsis, a life-threatening immune response to a bacterial infection.

At that point, doctors went ahead with the colonoscopy and finally found the toothpick piercing his colon. But, when they plucked it out, he began bleeding profusely. The doctors tried to pinch off the bleeding by placing nine clips in his intestines, but that didn’t work. They rushed him into surgery to stem the life-threatening bleeding and found that the toothpick had also slashed an artery—and it was in bad shape. They ended up cutting out a 3cm chunk of the artery and replaced it with tissue harvested from a vein in his leg. In doing that, they had to make slices in his leg to relieve pressure from the loss of circulation (aka a four-compartment fasciotomy).

About a week later, our forlorn protagonist was released from the hospital. He could walk on his own at that point, but he needed seven months of rehabilitation and training before he could play in another professional game. The doctors reported that, since his recovery, he “continues to have a substantial role in his sport.”

In an interview with The New York Times, one of his doctors reported that after the man was told that a toothpick was the culprit, he recalled that, shortly before he fell ill, he ate a sandwich that didn’t go down quite right.

Of the poor souls who somehow ingest one of the wee daggers, 79 percent will end up with stab wounds their innards. Ten percent will die from their toothpick-inflicted injuries.

These stats were based on the 136 individual cases written up in the medical literature, not the total numbers of ingested toothpicks. I couldn't find stats on that, but an article from 1984 (New York Times) estimated that about 8000 people per year were injured by toothpicks (ingesting, eye pokes, etc.).

A great story. Well not exactly "great" for them, but for us Ars readers. It's funny that Ars has always been about a few things... science, technology, gaming, cars, etc. But there's never seemed to be a strong "medical" angle going. Am I just mis-remembering the history? Room to expand!

This case is an eye opener but the stats are actually frightening; a 10% mortality rate is insane.

Given the damage that CAN occur, it would seem to me that a 10% mortality rate is pretty damned good.

As others have said, how the hell can you miss a nearly 3 inch toothpick in a sandwich (unless they simply bite and swallow)? And that had to have been a hell of a bite in the first place to not simply chomp it somewhere along its length and notice something weird.

Mom was right: Chew your food. Don't inhale it. Oddly, most people who are hurt by toothpicks are kids (usually eyes or ears). But apparently it takes an adult to really screw things up and swallow it.

It's funny that Ars has always been about a few things... science, technology, gaming, cars, etc. But there's never seemed to be a strong "medical" angle going. Am I just mis-remembering the history? Room to expand!

As I recall, there has been a steady - and extremely beneficial - uptick in medical reporting in Ars over recent years. Beth's bailiwick is definitely this stuff, as is the case for other writers.

I agree with your sentiment entirely, however. I am a technology geek, so it is refreshing for me to read up on biology, medicine, geology (Scott's articles) to widen my horizons.

"It seemed to me," said Wonko the Sane, "that any civilization that had so far lost its head as to need to include a set of detailed instructions for use in a package of toothpicks, was no longer a civilization in which I could live and stay sane."

Of the poor souls who somehow ingest one of the wee daggers, 79 percent will end up with stab wounds their innards. Ten percent will die from their toothpick-inflicted injuries.

These stats were based on the 136 individual cases written up in the medical literature, not the total numbers of ingested toothpicks. I couldn't find stats on that, but an article from 1984 (New York Times) estimated that about 8000 people per year were injured by toothpicks (ingesting, eye pokes, etc.).

Edit: someday I will get tags right the first time.

Indeed, here in the UK vast numbers of people present with severe eye injuries caused by drinking cups of tea. As noted in the comments to another article, our houses and electric systems are built around delivering 230v at 13amp to our kettles, which need around 3000w to deliver our daily cuppa.

The usual treatment, quite effective, is to suggest removing the spoon before drinking the tea.

Is it less dangerous if well chewed? I thought it was just a really toothy piece of bacon among other pieces of toothy bacon on my bacon burger. Go take another bite and there's half a toothpick and I'm picking little bits of cellophane out of my teeth because it was a fancy toothpick.

[quote="[url=https://arstechnica.com/civis/viewtopic.php?p=36778645#p36778645]Indeed, here in the UK vast numbers of people present with severe eye injuries caused by drinking cups of tea. As noted in the comments to another article, our houses and electric systems are built around delivering 230v at 13amp to our kettles, which need around 3000w to deliver our daily cuppa. [/quote]

I am UKian, now living in Switzerland, and was devastated to discover that the electrical system in my apartment in Zürich is inadequate to power my 3kW British kettle. I had to buy a local 1kW model instead, which is significantly inferior.